First Edition: November 20, 2012

Today's headlines include the latest news on the "fiscal cliff" negotiations as well as reports about the health law's implementation.

Kaiser Health News: Insuring Your Health: Advocates Of Medical Marijuana Face Another Hurdle: Insurance Coverage
In her latest Kaiser Health News consumer column, Michelle Andrews writes: "With the passage of a ballot initiative this month, Massachusetts became the latest state to allow the use of marijuana for medical purposes, joining 17 others and the District of Columbia. But for patients who use marijuana to help alleviate chronic pain and nausea and stimulate appetite, legalization is only part of the battle. Health insurance rarely if ever covers its use; some patients spend hundreds of dollars a month or more on the drug. The situation may not change anytime soon, some experts say" (Andrews, 11/19). Read the column.

Kaiser Health News: Capsules: Uninsured Die At Higher Rate After Brain Surgery, Study Finds; States Detail Questions About Their Exchange Options; Survey: Maryland Voters Know Little About Federal Health Law; NFL Records Go High-Tech
Now on Kaiser Health News' blog, Alvin Tran reports on a study involving mortality rates, brain surgery and people without insurance: "According to the findings of a new study by Johns Hopkins University researchers, uninsured patients died at a higher rate after receiving brain surgery to remove cancerous tumors than those with private insurance. Uninsured patients had a death rate of 2.6 percent, compared to 1.3 percent among the privately insured, a statistically significant difference" (Tran, 11/20).

Also on Capsules, Ankita Rao reports on some states' questions about health insurance exchanges: "Iowa Gov. Terry Branstad said Friday that he will build a health exchange in his state – as soon as the Obama administration can explain exactly what that means. The Republican governor submitted 50 questions to Health and Human Services Secretary Kathleen Sebelius about how the state-built online insurance markets are supposed to be set up. … Branstad and New Jersey Gov. Chris Christie, also a Republican, are more public than some other state leaders in their criticism of the health law, but they are not the only ones demanding answers on how the exchanges must be set up. A National Association of Insurance Commissioners committee is compiling a working document of state queries about exchange regulations, which had 40 questions as of Monday afternoon" (Rao, 11/19).

In another post, Tran reports on a survey exploring how much Maryland voters know about the health law: "Although Maryland is a leader in implementing major provisions of the federal health law, many of its voters are still unsure of what changes are actually in store for them. The results of a new poll, released Monday, found that while the majority of Maryland voters support the measure, only 30 percent of survey respondents know a lot about its specific provisions" (Tran, 11/19).

And Shefali S. Kulkarni reports on how NFL medical records are going high tech: "Given the increased interest in providing better care for players, including more emphasis on concussions, National Football League officials announced Monday a new way to track and treat injuries. The NFL said it is implementing an electronic health records system that will eventually be adopted by all 32 teams" (Kulkarni, 11/19). Check out what else is on the blog.

The Wall Street Journal: Entitlements Split Democrats
With deficit talks kicking off in earnest, Democrats are divided on the magnitude of changes they would accept when it comes to overhauling Medicare and other safety-net programs. The party is split between those who would agree to major adjustments, including increasing premiums for wealthier beneficiaries and raising Medicare's eligibility age, and those who rule out such moves altogether. In the middle is a group that would tolerate some cuts as long as they didn't hit beneficiaries directly (Bendavid and Hook, 11/19).

Politico: Democrats Have Own Fiscal Cliff Issues
Senate Majority Leader Harry Reid (D-Nev.) will have to find 60 votes to extend just the middle-income tax rates — far from a given when a swath of the Senate's moderate Democrats are up for reelection in 2014. Reid and the White House will also need to navigate a hardening Democratic divide on entitlements. Progressives don't want any deep cuts that Republicans will insist on for a deal. But a Third Way poll of 800 Obama voters set for release Tuesday found that efforts to fix Medicare and Social Security enjoy broader support than liberals suggest (Sherman, Budoff Brown and Bresnahan, 11/19).

The New York Times: For Tax Pledge And Its Author, A Test Of Time
Next to the oath of office, it has been perhaps the most important commitment that Republicans in Congress can make. It is called simply "the Pledge," and its enforcer is such a fixture in the party that he is known simply by his first name, Grover. … But the pledge and its creator, Grover Norquist, a 56-year-old conservative lobbyist, have never before faced a test as they do now. The federal deficit stands at $1 trillion. The social safety net continues to grow — and, in the case of Medicare and Social Security, remains hugely popular. And unless the two parties can agree on a fiscal plan before Jan. 1, hundreds of billions of dollars of tax increases will go into effect automatically, meaning that Congress does not even need to act for taxes to rise (Peters, 11/19).

The Wall Street Journal's Washington Wire: Rivlin Sees A Two-Step Plan To Avoid The Fiscal Cliff
Alice Rivlin, who once led both the congressional and White House budget offices, says a two-step solution can get Washington past the so-called fiscal cliff at year’s end and set the table for a long-term budget solution. … She also said she continues to favor finding ways to introduce more competition into the Medicare program. Under "premium support," the approach House Budget Committee chairman and Republican vice presidential nominee Rep. Paul Ryan has advocated, the government helps senior citizens pay the premiums on health policies they acquire on their own (Seib, 11/19).

Politico: Medicare Cuts Give Health Providers Jitters
The $716 billion in Medicare "cuts" that got so much attention in the presidential election have already begun sinking their teeth into health care providers. And there are widespread jitters that any further cuts as part of a year-end deal to stave off sequestration or strike a "grand bargain" for a long-term fiscal deal would deeply gouge some providers, if not put them out of business (Norman, 11/20).

Politico: Next Up For Obamacare: Launching The Exchanges In 2014
Now that the elections saved the health care law from the threat of repeal, the Obama administration and its backers are turning their attention toward getting the law right — before the next elections come around in 2014 (Haberkorn, 11/20).

Politico: HHS Looks To Step Up Role In Health Exchanges
The last thing the Obama administration wanted to do was come into a bunch of states and start running health insurance exchanges. But when the new insurance marketplaces open for business late next year, it's clear that the Department of Health and Human Services will have a much bigger job than it wanted (Millman, 11/20).

Politico: Can The IRS Handle Obamacare?
Now that the health care law's future is finally secure, it's up to the Internal Revenue Service to make sure the money flows. But only the right amount of money. And only to the people who are supposed to get it (Cunningham, 11/20).

The Washington Post: Judge Grants Company Injunction Against Health-Care Law Contraception Efforts
A federal judge on Friday temporarily prevented the Obama administration from forcing a Christian publishing company to provide its employees with certain contraceptives under the new health-care law. U.S. District Judge Reggie Walton granted a preliminary injunction sought by Tyndale House Publishers, which does not want to provide employees with contraceptives that it equates with abortion (Frommer, 11/19).

Los Angeles Times: U.S. Panel Advises HIV Tests For Everyone Ages 15 to 64
Nearly everyone ages 15 to 64 should be screened for HIV even if they're not at great risk for contracting the virus, according to new guidelines proposed by an influential panel of medical experts. If the panel ultimately adopts those recommendations, Medicare and most private health insurers will be required to pay for the tests (Mestel, 11/19).

The Wall Street Journal: Health Panel Back Broad HIV Tests
The panel's recommendation is significant because, if finalized, private insurers would have to pay for the test. Past recommendations haven't always been embraced by doctors. But in this instance, the weight of medical evidence has already been trending in favor of screening and earlier treatment of people with HIV (Burton and McKay, 11/19).

USA Today: Panel Recommends Routine HIV Tests For Teens, Adults
In a broad new expansion of HIV screening, an influential government panel now says everyone ages 15 to 65 should be tested for the virus that causes AIDS. The draft recommendation, issued Monday by the U.S. Preventive Services Task Force, is far broader than its last recommendation in 2005, which called for screening only those at high risk (Szabo, 11/19).

The Associated Press/USA Today: Senate Questions Pharmacy Boards After Meningitis Cases
A Senate committee investigating the deadly outbreak of meningitis wants to know how regulators in all 50 states oversee specialty pharmacies like the one that triggered the illness. The Senate Committee on Health, Education, Labor and Pensions sent letters Monday to all 50 state boards of pharmacy, seeking details about their oversight of compounding pharmacies (11/19).

The New York Times: Deaths Stir A Dispute On Powers Of FDA
Representative John D. Dingell, Democrat of Michigan, thumped his desk in exasperation as he questioned Dr. Margaret A. Hamburg, the Food and Drug Administration commissioner, during last week's Congressional hearing on the meningitis outbreak caused by a tainted drug. Other lawmakers had already accused Dr. Hamburg of evading their questions (Grady, 11/19).

The Wall Street Journal: Health-Care Executives At Center Of Alleged Insider-Trading Scheme
Secrets passed at recreational basketball games, code words and calls on a pay phone outside a Virginia K-Mart marked what prosecutors say was a five-year insider-trading scheme fueled by corporate secrets leaked by health-care executives. Federal prosecutors in New Jersey have accused six men — including former executives at pharmaceutical company Celgene Corp. and medical-technology firm Stryker Corp. and some of their high-school friends — of passing corporate secrets about their companies and using that information to make profitable trades. The scheme allegedly began in 2007, involved 11 corporate announcements and resulted in more than $1.4 million in illicit profits (Bray, 11/19).

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